Improved Stroke Fast Track Strategy leads to 6 Minutes Door-To-Needle Time

Authors

  • Bodeepat Worathitianan 0865711462

Keywords:

strategy, stroke, fast track, door-to-needle time

Abstract

Stroke fast track protocol which administrating rtPA to the patient at emergency department, Nakhonpathom hospital has started since April 2016. The protocol increased the patients who received rtPA and improved door-to-needle time. Lastly during April 2018 to March 2019, for 1 year, 195 patients received rtPA. The rtPA treatment rate was 13.2%. Mean door-toneedle time was 36 minutes. Several strategies were adopted to continuously improve doorto-needle time. The best door-to-needle time was 6 minutes.

References

1. Powers WJ, Rabinstein AA, Ackerson T, Adeoye OM, Bambakidis NC, Becker K, et el. 2018 Guidelines for the Early Management of Patients With Acute Ischemic Stroke: A Guideline for Healthcare Professionals From the American Heart Association/American Stroke Association. Stroke [Internet]. 2018 [cited 2019 July 18]; 49(3): e46–e99. Available from: https://www.ahajournals.org/doi/full/10.1161/STR.0000000000000158
2. Fonarow GC, Zhao X, Smith EE, Saver JL, Reeves MJ, Bhatt DL, et el. Door-to-Needle Times for Tissue Plasminogen Activator Administration and Clinical Outcomes in Acute Ischemic Stroke Before and After a Quality Improvement Initiative. JAMA [Internet]. 2014 [cited 2019 July 18]; 311(16): 1632-40. Available from: https://jamanetwork.com/journals/jama/fullarticle/1861802
3. Saver JL. Time Is Brain—Quantified. Stroke. 2006; 37(1): 263-6.
4. Kamal N, Smith EE, Jeerakathil T, Hill MD. Thrombolysis: Improving door-to-needle times for ischemic stroke treatment – A narrative review. International Journal of Stroke [Internet]. 2018 [cited 2019 July 18]; 13(3): 268-76. Available from: https://www.researchgate.net/publication/321091361_Thrombolysis_Improving_door-to-needle_times_for_ischemic_stroke_treatment_-_A_narrative_review
5. Kamal N, Holodinsky JK, Stephenson C, Kashayp D, Demchuk AM, Hill MD. Improving Door-to-Needle Times for Acute Ischemic Stroke: Effect of Rapid Patient Registration, Moving Directly to Computed Tomography, and Giving Alteplase at the Computed Tomography Scanner. Circ Cardiovasc Qual Outcomes [Internet]. 2017 [cited 2019 July 18]; 10(1). Available from: https://www.ahajournals.org/doi/10.1161/CIRCOUTCOMES.116.003242
6. Xian Y, Xu H, Lytle B, Blevins J, Peterson ED, Hernandez AF. Use of Strategies to Improve Door-to-Needle Times With Tissue-Type Plasminogen Activator in Acute Ischemic Stroke in Clinical Practice: Findings from Target: Stroke. Circ Cardiovasc Qual Outcomes[Internet]. 2017[cited 2019 July 18]; 10(1). Available from: https://www.ahajournals.org/doi/full/10.1161/CIRCOUTCOMES.116.003227
7. Fonarow GC, Smith EE, Saver JL, Reeves MJ, Hernandez AF, Peterson ED, et al. Improving door-to-needle times in acute ischemic stroke: the design and rationale for the American Heart Association/American Stroke Association’s Target: Stroke initiative. Stroke[Internet]. 2011[cited 2019 July 18]; 42(10): 2983-9. Available from : https://www.ahajournals.org/doi/10.1161/STROKEAHA.111.621342
8. บดีภัทร วรฐิติอนันต์, ชัชฎาพร โอศิริ. การพัฒนาการจัดการโรคหลอดเลือดสมองขาดเลือดเฉียบพลันผ่านช่องทางด่วน ณ ห้องฉุกเฉิน รพ.นครปฐม. วารสารแพทย์เขต 4-5 [อินเตอร์เน็ต]. 2560 [เข้าถึงเมื่อ 18ก.ค.2562]; ฉบับที่ 36(4): 251-263. เข้าถึงได้จาก: https://digitaljournals.moph.go.th/tdj/index.php/RMJ/article/view/2387
9. บดีภัทร วรฐิติอนันต์. ระบบช่องทางด่วนโรคหลอดเลือดสมอง ณ ห้องฉุกเฉิน โรงพยาบาลนครปฐม: ความท้าทายก้าวสู่แนวปฏิบัติที่ดีเลิศในประเทศไทย. วารสารประสาทวิทยาแห่งประเทศไทย[อินเตอร์เน็ต]. 2562 [เข้าถึงเมื่อ 18ก.ค.2562]; ฉบับที่ 35(2): 17-29. เข้าถึงได้จาก: http://neurothai.org/images/journal/2019/vol35_no2/17-29Original.pdf
10. Heikkilä I, Kuusisto H, Stolberg A, Palomäki A. Stroke thrombolysis given by emergency physicians cuts in-hospital delays significantly immediately after implementing a new treatment protocol. Scand J Trauma Resusc Emerg Med. 2016; 24: 46.
11. Volans AP. An analysis of outcomes of emergency physician/department-based thrombolysis for stroke. Emerg Med J. 2012; 29(8): 640-3.
12. Smith RW, Scott PA, Grant RJ, Chudnofsky CR, Frederiksen SM. Emergency Physician Treatment of Acute Stroke with Recombinant Tissue Plasminogen Activator: A Retrospective Analysis. Acad Emerg Med. 1999; 6(6): 618-25.

Downloads

Published

2020-04-21

How to Cite

1.
Worathitianan B. Improved Stroke Fast Track Strategy leads to 6 Minutes Door-To-Needle Time. J Thai Stroke Soc [Internet]. 2020 Apr. 21 [cited 2024 Jun. 22];19(1):5. Available from: https://he01.tci-thaijo.org/index.php/jtss/article/view/203735

Issue

Section

Original article